LTC Claims Training- Region 11 January 2014

Transcription

1 LTC Claims Training- Region 11 January 2014

2 Submitting Claims All Providers must submit claims in order to receive payment each month. Claims can be submitted in the following ways: On paper, using a current version CMS 1500 form Electronically, via Molina Healthcare s Web Portal Electronically, via a clearinghouse

3 Direct Deposit of Funds Providers are encouraged to enroll in Electronic Funds Transfer (EFT) in order to receive payments quicker. Molina Healthcare s EFT provider is ProviderNet. To enroll, visit:

4 LTC HCPCS Listing

5 Code Mod #1 Service Unit Reimbursement S5135 Adult Companion Services 15 minute-unit S5100 Adult Day Health Care 15 minute-unit T1020 Assisted Care Services per day T2030 Assisted Living Services per day S5125 Attendant Care Services 15 minute-unit H2019 Behavioral Management Intervention per visit H2020 Behavioral Management Assessment per visit S5110 Caregiver Training/ Support- Group 15 minute-unit Caregiver Training/ Support- Individual 15 minute-unit G9002 Case Management 15 minute-unit S5165 Home accessibility Adaptation Services per job S5170 Home Delivered Meals per meal S5130 Homemaker Services 15 minute-unit G9004 Homemaker Services- Pest Control-Initial Visit per visit G9005 Homemaker Services- Pest Control-Maintenance per month T1002 HN Intermittent and Skilled Nursing, BSN per visit T1002 Intermittent and Skilled Nursing, RN per visit T1003 Intermittent and Skilled Nursing, LPN per visit E1399 Specialized Medical Equipment and supplies per authorization E1399 AU Specialized Medical Equipment and supplies for trach supplies per authorization S5199 Medical Equipment And Supplies, Personal Care Item Regular Miscellaneous per authorization S5199 AU Medical Equipment And Supplies, Personal Care Item for Trach Miscellaneous per authorization T1502 HN Medication Administration of oral, intramuscular, and or sub medication by BSN per visit Medication Administration of oral, intramuscular, and or sub medication by per visit T1502 TD RN T1502 TE Medication Administration of oral, intramuscular, and or sub medication by LPN per visit

6 T1503 T1503 T1503 Code Mod #1 Service HN TD TE Medication Administration other than of oral, intramuscular, and or sub medication by BSN Medication Administration other than of oral, intramuscular, and or sub medication by RN Medication Administration other than of oral, intramuscular, and or sub medication by LPN H2010 HN Medication Management Comprehensive Medication Services, BSN H2010 TD Medication Management Comprehensive Medication Services, RN H2010 TE Medication Management Comprehensive Medication Services, LPN Unit Reimbursement per visit per visit per visit 15 minute-unit 15 minute-unit 15 minute-unit Nutritional Risk Reduction 15 minute-unit T1019 Personal Care 15 minute-unit S5160 Personal Emergency Response System Installation per day S5161 Personal Emergency Response System Maintenance per day S5150 Respite-In-Home 15 minute-unit T1005 Respite-Facility-Based 15 minute-unit Occupational Therapy (Enrollees over age 21) flat rate per day Physical Therapy (Enrollees over age 21) flat rate per day S5180 Respiratory Therapy Evaluation flat rate per day Respiratory Therapy Treatment Regualr (Enrollees over age 21) flat rate per day Respiratory Therapy, Treatment mechanical vent care flat rate per day Speech Therapy ( Enrollees over 21 of age) flat rate per day

7 Billing Using a CMS 1500 Form Providers must complete the following fields on the CMS-1500 in order for the claim to be processed. Field Description/Comment 1 Check the Medicaid box 1a Enter the Member s Molina Healthcare of Florida Community Plus ID Number 2 Enter the Member s Name 3 Enter the Member s Date of Birth and Sex 5 Enter the Member s Address and Telephone Number 6 Enter Self 12 Enter Signature on File 13 Enter Signature on File 21 (1) Enter the diagnosis code of a Enter the Date(s) of Service 24b Enter the Place of Service (12 Patient s Home; 13 - ALF; 99 - Other) 24d Enter appropriate CPT/HCPCS and Modifier 24e Enter the number 1 24f Enter the customary Charge for the CPT/HCPCS, Modifier for the total days or units billed on the claim line 24g Enter Days or Units of Service 25 Enter Federal Tax I.D. Number 26 Enter Member Account Number 27 Enter Yes to accept assignment 28 Enter Total Charge for all line items 30 Enter the Balance Due (same as Field 28) 31 Signature of Provider s Representative 33 Provider Billing Name, Address, Zip Code 33a Enter NPI, if applicable

8 How to Bill Long Term Care Claims To bill for long term care services, follow these steps: Identify the HCPCS code and modifier (if applicable). Determine the unit increment in the HCPCS code definition (noted on the LTC HCPCS Listing in the unit reimbursement column). Decide the billing frequency you will use for billing (daily, weekly, or monthly) Determine the total amount of units to be billed.

9 Reporting Units on Claims Case Study Jose Perez is receiving 2 hours of personal care and 3 hours of homemaker, 3 times a week, through his assigned home health agency in the month of January. To bill for these services, follow these steps: Identify the HCPCS code and modifier (if applicable). Personal Care is T1019, no modifier Homemaker is S5130, no modifier Determine the unit increment in the HCPCS code definition (noted on the LTC HCPCS Listing in the unit reimbursement column). Personal Care and Homemaker code definition requires billing in 15- minute increments. ( 15 minutes = 1 unit ; 1 hour = 4 units) Decide the billing frequency used for billing (daily, weekly, or monthly) Determine the total amount of units to be billed. LTC Service HCPC Number of hours per day # of 15 Minute Increments Total Units Daily Number of Service Days in Week Total Weekly Units Personal Care T Homemaker S

10 Correct Billed Claim

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12 Incorrect Billed Claim

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14 Submitting a Corrected Claim Corrected Claims can be submitted in the following way: CMS 1500 Form ( indicate on the top of the form corrected claim not a duplicate claim ). The corrected claim must be a replacement of the original claim. DO NOT submit a claim for the additional services only.

15 Sample of Corrected Claim

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17 How to Bill Claims for Respite Care Case Study Jose Perez is receiving 8 hours of respite care, for one week, through his assigned provider in the month of January. To bill for these services, follow these steps: Identify the HCPCS code and modifier (if applicable). Respite in Facility is T1005, no modifier Determine the unit increment in the HCPCS code definition (noted on the LTC HCPCS Listing in the unit reimbursement column). Respite Care is billed in 15-minute increments. ( 15 minutes = 1 unit ; 1 hour = 4 units) The billing frequency for Respite Care is daily only. Date spans cannot be used for this service due to the contractual daily maximums associated with this service. Each Date of Service needs to be billed in an individual line of the claim.

18 Sample of Respite Claim

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20 Questions